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Scholarly Works (41 results)

  • Thesis
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UCLA Electronic Theses and Dissertations (2013)

Frailty, a public health challenge may be a significant issue among homeless and disenfranchised populations in urban and rural cities across the United States (U.S.). The purpose of this dissertation is to characterize frailty among a sample of 150 homeless men and women. The first manuscript developed a theoretical framework, the Frailty Framework among Homeless and Vulnerable Populations (FFHVP), based on previous models and empirical literature in order to guide two data based papers, namely correlates of frailty and to test a modified FFHVP in order to determine predictors using structural equation modeling (SEM). The second manuscript utilized descriptive, univariate, and multiple regressions to understand predictors. A Pearson (r) bivariate correlation revealed a weak relationship between frailty and being female (r =.230, p<.01). Significant moderate negative correlations were found between frailty and resilience (r = -.395, p<.01), social support (r = -.377, p<.01), and nutrition (r = -.652, p<.01). Further, Spearman rho (r) bivariate correlations revealed a moderate positive relationship between frailty and health care utilization (r =.444, p<.01). A stepwise backward linear regression analysis was conducted and in the final model, age, female gender, health care utilization, nutrition and resilience were significantly related to frailty. The multiple correlation squared was .542, indicating that 54.2% of the variance in frailty could be explained by the variables in the model. The third manuscript examined situational, behavioral, health-related and resource indicators in terms of their direct impact on frailty, hypothesized as a latent variable construct. Using SEM, a model was tested with 150 homeless men and women, ages 40 to 73. Except for age and drugs, all of the independent variables were significantly associated with frailty in the confirmatory factor analysis (CFA); these included months homeless (p<.01), female gender (p<.05), education (p<.05), comorbid conditions (p<.001), nutrition (p<.001), resilience (p<.001), health care utilization (p<.01), and falls (p<.001). In the final path model, significant predictors of frailty included educational attainment (p<.01), comorbid conditions (p<.001), nutrition (p<.001), resilience (p<.001), and falls (p<.01). However, age, gender, length of time homeless, health care utilization and drug use did not emerge as significant in the path model. These findings reframe concepts; specifically, physical, psychological and social frailty domains which investigators have been independently and collaboratively researching for decades with the ultimate goal of developing future nurse-led intervention initiatives.

    Cover page: Characterizing Frailty among Homeless Adults
    • Article
    • Peer Reviewed
    UC Irvine Previously Published Works (2013)
    In a prospective two-group pilot study of a convenient sample of 156 young adults, we assessed improvement in HIV cognitive and transmission knowledge, hepatitis knowledge, and mental health at six-month follow-up. Multiple linear regression analysis revealed higher six-month scores in total HIV/AIDS knowledge, HIV/AIDS cognitive knowledge, HIV transmission knowledge and HBV and HCV knowledge at 6 months in the Hepatitis Health Promotion (HHP) group compared to the Art Messaging (AM) group. Moreover, homeless young participants who reported having significant others in their lives, and excellent or very good health did better than their counterparts. Youth who were attempting to get their lives together had higher scores for all types of knowledge except HBV. Hallucinogen users had significantly worse scores on all knowledge measures than non-users. Lastly, the HHP group revealed an improvement in psychological well-being compared to the AM group.
      Cover page: Impact of Nursing Intervention on Improving HIV, Hepatitis Knowledge and Mental Health Among Homeless Young AdultsCreative Commons 'BY' version 4.0 license
      • Article
      • Peer Reviewed
      UC Irvine Previously Published Works (2014)
      This cross-sectional study of 540 homeless ex-offenders exiting prisons and jails assessed sociodemographic, childhood, and drug-related differences. Older ex-offenders from prison were more likely to have been married, come from a two-parent family, and used crack, whereas younger ex-offenders from prison were more likely to have used methamphetamine. Older ex-offenders from jail were more likely to be African American, have children, and report a history of crack and injection drug use, whereas younger ex-offenders from jail were more likely to have engaged in binge drinking and be in a gang. Our findings showcase the need to understand unique correlates of younger and older incarcerated populations.
        Cover page: Substance use trends among younger vs. older homeless parolees.Creative Commons 'BY' version 4.0 license
        • Article
        • Peer Reviewed
        UC Irvine Previously Published Works (2018)
        The purpose of this pilot randomized controlled trial (RCT) was to compare the 6-month outcomes of a Dialectical Behavioral Therapy-Corrections Modified (DBT-CM) program versus a Health Promotion (HP) program on mitigating recidivism among 130 female parolees/probationers between baseline and 6-month follow-up. The effect of DBT-CM on reducing recidivism was greater among those who expressed a desire for help (risk ratio [RR] = 0.40; 95% confidence interval [CI] = [0.16, 1.00]; p = .050) and among homeless female ex-offenders (HFOs) who were younger (<50 years of age; RR = 0.46; 95% CI = [0.19, 1.11]; p = .085) and participants with Desire for Help score > 35 (Model 3; RR = 0.40; 95% CI = [0.16, 1.00]; p = .050). Findings from this pilot study suggest that the DBT-CM intervention may be effective in reducing reincarceration rates among some HFOs during reentry. Larger RCTs are needed to validate our findings.
          Cover page: Effectiveness of Dialectical Behavioral Therapy on Reduction of Recidivism Among Recently Incarcerated Homeless Women: A Pilot StudyCreative Commons 'BY' version 4.0 license
          • Article
          • Peer Reviewed
          UC Irvine Previously Published Works (2014)
          High levels of hostility present a formidable challenge among homeless ex-offenders. This cross-sectional study assessed correlates of high levels of hostility using baseline data collected on recently-released male parolees (N=472; age 18-60) participating in a randomized trial focused on prevention of illicit drug use and recidivism. Predictors of high levels of hostility included greater depressive symptomatology, lower self-esteem, having a mother who was treated for alcohol/drugs, belonging to a gang, more tangible support, having used methamphetamine and having a history of cognitive difficulties. These findings highlight the need to understand predictors of hostility among recently released homeless men and how these predictors may relate to recidivism. Research implications are discussed as these findings will shape future nurse-led harm reduction and community-based interventions.
            Cover page: Predictors of High Level of Hostility Among Homeless Men on ParoleCreative Commons 'BY' version 4.0 license
            • Article
            • Peer Reviewed
            UC Irvine Previously Published Works (2014)
            Frailty is a public health issue that is experienced by homeless and other vulnerable populations; to date, a frailty framework has not been proposed to guide researchers who study hard-to-reach populations. The Frailty Framework among Vulnerable Populations has been developed from empirical research and consultation with frailty experts in an effort to characterize antecedents, that is, situational, health-related, behavioral, resource, biological, and environmental factors that contribute to physical, psychological, and social frailty domains and impact adverse outcomes. As vulnerable populations continue to age, a greater understanding of frailty will enable the development of nursing interventions.
              Cover page: Development of a Frailty Framework Among Vulnerable Populations
              • Article
              • Peer Reviewed
              UCLA Previously Published Works (2017)
              Interventions are needed to address frailty and other behaviors (e.g., drug and alcohol use) among prefrail and frail homeless women (P/FHW). The purpose of this pilot randomized controlled trial (RCT) was to compare the efficacy of a Frailty Intervention (FI) versus a Health Promotion (HP) program among P/FHW (N = 32). Structured instruments assessed sociodemographics, individual, situational, health-related, and behavioral factors. While program differences were not statistically significant with the main outcome variables, medium-to-large effect sizes were found in favor of the HP program as it relates to physical and overall frailty, as well as, any drug use, alcohol use, and drug dependency. Based on these findings, it is critical to strengthen the HP program to optimize all domains of frailty (e.g., physical, psychological, and social) and substance use for P/FHW.
                Cover page: Impact of a Community-Based Frailty Intervention Among Middle-Aged and Older Prefrail and Frail Homeless Women: A Pilot Randomized Controlled Trial
                • Article
                • Peer Reviewed
                UC Irvine Previously Published Works (2017)
                A randomized controlled trial was conducted with homeless gay and bisexual men to assess the impact of two culturally sensitive intervention programs on reduction of drug use and risky sexual behavior. In this study, gay and bisexual men between 18 and 46 years of age were randomly assigned to one of two culturally sensitive behavioral intervention programs: a Nurse Case Management Plus Contingency Management (NCM + CM; n = 204) or a Standard Education Plus Contingency Management (SE + CM; n = 210) program. Regardless of group assignment, significant and clinically relevant reductions were observed in stimulant use over time. Multivariable predictors of stimulant use at 4- and 8-month follow-up evaluations were recent injection drug use, tested positive for HIV, or for use of amphetamine. Data revealed a significant linear decline over time for those who had sex with multiple partners. Furthermore, being HIV positive was associated with reporting multiple partners, while higher homophobia scores and having children were inversely related to reports of having sex with multiple partners at follow-up. Culturally sensitive approaches are needed to successfully reduce drug use and risky sexual activities among gay and bisexual populations.
                  Cover page: Impact of Tailored Interventions to Reduce Drug Use and Sexual Risk Behaviors Among Homeless Gay and Bisexual MenCreative Commons 'BY' version 4.0 license
                  • Article
                  • Peer Reviewed
                  UCLA Previously Published Works (2015)

                  Background

                  Although hepatitis A virus (HAV) and hepatitis B virus (HBV) infections are vaccine-preventable diseases, few homeless parolees coming out of prisons and jails have received the hepatitis A and B vaccination series.

                  Objectives

                  The study focused on completion of the HAV and HBV vaccine series among homeless men on parole. The efficacy of three levels of peer coaching (PC) and nurse-delivered interventions was compared at 12-month follow-up: (a) intensive peer coaching and nurse case management (PC-NCM); (b) intensive PC intervention condition, with minimal nurse involvement; and (c) usual care (UC) intervention condition, which included minimal PC and nurse involvement. Furthermore, we assessed predictors of vaccine completion among this targeted sample.

                  Methods

                  A randomized control trial was conducted with 600 recently paroled men to assess the impact of the three intervention conditions (PC-NCM vs. PC vs. UC) on reducing drug use and recidivism; of these, 345 seronegative, vaccine-eligible subjects were included in this analysis of completion of the Twinrix HAV/HBV vaccine. Logistic regression was added to assess predictors of completion of the HAV/HBV vaccine series and chi-square analysis to compare completion rates across the three levels of intervention.

                  Results

                  Vaccine completion rate for the intervention conditions were 75.4% (PC-NCM), 71.8% (PC), and 71.9% (UC; p = .78). Predictors of vaccine noncompletion included being Asian and Pacific Islander, experiencing high levels of hostility, positive social support, reporting a history of injection drug use, being released early from California prisons, and being admitted for psychiatric illness. Predictors of vaccine series completion included reporting having six or more friends, recent cocaine use, and staying in drug treatment for at least 90 days.

                  Discussion

                  Findings allow greater understanding of factors affecting vaccination completion in order to design more effective programs among the high-risk population of men recently released from prison and on parole.
                    Cover page: Nursing case management, peer coaching, and hepatitis a and B vaccine completion among homeless men recently released on parole: randomized clinical trial.
                    • Article
                    • Peer Reviewed
                    UC Irvine Previously Published Works (2013)
                    Rural women living with HIV/AIDS (WLA) in India face multifarious challenges which affect access to antiretroviral regimens and management of HIV/AIDS. The purpose of this pilot study, using cluster randomization, is to compare the effectiveness of the Asha-Life (AL) intervention, delivered by HIV-trained village women, Asha (Accredited Social Health Activists), with a usual care group on reduction of internalized stigma and avoidant coping among 68 WLA in rural India over a 6-month period. The findings demonstrated that participation in the AL intervention was associated with significant reductions in internalized stigma and the use of avoidant coping strategies at follow-up. The findings of our study are promising in terms of the role rural village women (Asha) may play in reducing internalized stigma and avoidant coping in the lives of rural WLA in India.
                      Cover page: Impact of Asha Intervention on Stigma Among Rural Indian Women With AIDSCreative Commons 'BY' version 4.0 license
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